The investigators studied 64 cases of severe infection in 31 patients treated over an 11-year period (1996-2007) at a referral institution in southern Thailand. The infections were fatal in 13 patients (41.9%). Eleven of these deaths resulted from the first infective episode.

Fungi and gram-negative bacilli were the major causative pathogens. Prior treatment with pulse methylprednisolone was associated with an 11.2 times increased risk of a fatal infection after adjusting for potential confounders. Fungal infections and renal failure were associated with a nearly 24-fold and sixfold increased risk of death, respectively.

Children with active LN who have been treated with IVCY and pulse methylprednisolone and later develop a severe infection that fails to respond to antibiotics should be carefully investigated for fungal infection, the authors concluded.